Does stabilizing female hormones help lower suicide risk?

A three-year, $750,000 grant from the National Institutes of Mental Health will help researchers determine whether the stabilization of ovarian hormones estradiol and progesterone can help lower symptoms associated with suicidality among females at risk for suicide.

While estradiol and progesterone rise and fall over the course of the menstrual cycle, the hormones plummet to their lowest levels just before and during menses.

"In most women, estradiol and progesterone are associated with feelings of well-being and calm," said Tory Eisenlohr-Moul, assistant professor of psychiatry in the UIC College of Medicine, and principal investigator on the grant. "In our previous research in females with chronic suicidality, stabilizing both estradiol and progesterone protected women against increased depression and thoughts of suicide around menses. In this study, we want to determine whether stabilizing estradiol or progesterone alone (instead of together) will have the same protective effect on hopelessness, desire for suicide and suicidal planning among suicidal females."

Suicide is the second leading cause of death worldwide among females of reproductive age, and several studies have suggested that the changing hormone levels associated with the menstrual cycle may be correlated to when suicide attempts are more likely to occur for those who are suicidal.

"For someone who is suicidal, these changes in hormones, especially if that person is extra sensitive to these changes, could be a contributing factor in pushing them over the edge and to a suicide attempt," Eisenlohr-Moul said. "If hormone stabilization can prevent that push, we may be able to save lives."

Eisenlohr-Moul and her colleagues will recruit 30 females who had suicidal symptoms in the previous 30 days but who are not on birth control. They will compare symptoms of suicidality among the participants across three experimental conditions: one menstrual cycle where placebos are given during the perimenstrual period; one cycle where estradiol is stabilized during the perimenstrual period; and one cycle where progesterone is stabilized during the perimenstrual period. Hormones will be administered by a transdermal patch. In between each condition, participants will be allowed to freely cycle for one menstrual cycle with no hormone patches or placebos.

Participants will record levels of depression, hopelessness, and suicidality daily on their smartphones. Blood will be drawn each week during experimental conditions to evaluate levels of estradiol and progesterone as well as inflammatory markers that have been linked to depression and suicide.

"Right now we don't know if stabilizing one of these two hormones is driving the protective effect on suicidality or if both have the same effect, so that's the main thing we want to investigate," said Eisenlohr-Moul. "We are also looking at how the immune system is affected during the two experimental conditions, and if hormone stabilization might help to keep suicide-promoting inflammation at bay during the risky part of the menstrual cycle."

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Susan Girdler of the University of North Carolina at Chapel Hill is a co-investigator on the grant.